Citation Nr: 21063553
Decision Date: 10/14/21	Archive Date: 10/14/21

DOCKET NO. 19-25 494
DATE: October 14, 2021

REMANDED

Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded.

Entitlement to service connection for diabetes mellitus type II (DM2) is remanded.

REASONS FOR REMAND

The Veteran served on active duty from April 1976 to January 1983, and from December 1990 to May 1991.

In February 2020, the Board remanded the issues on appeal for further development, and the case has since been returned to the Board. The Board finds that the AOJ has not substantially complied with the remand directives.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).

Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected PTSD is remanded.

In the February 2020 remand, the Board directed the AOJ to provide an opinion on the etiology of the Veteran's OSA. Specifically, the examiner was asked to opine as to whether the Veteran's OSA was caused by service-connected PTSD or was aggravated by service-connected PTSD. 

In response, an opinion was provided in August 2021. However, the examiner failed to provide an opinion on aggravation. Accordingly, an addendum opinion is required. 

Entitlement to service connection for DM2 is remanded.

In the February 2020 remand, the Board directed the AOJ to provide an opinion on the etiology of the Veteran's DM2. Specifically, the examiner was asked whether the Veteran's diabetes was related to an injury or disease during service, including environmental exposures in Southwest Asia during the Persian Gulf War.

In response, an opinion was provided in August 2021. However, the examiner failed to discuss the Veteran's environmental exposures in Southwest Asia during the Persian Gulf War and whether his DM2 was a result thereof. Accordingly, an addendum opinion is required.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding whether any sleep apnea experienced by the Veteran since approximately January 2018 at least as likely as not is aggravated by service-connected PTSD.

For purposes of the above opinion, the clinician shall presume that the Veteran's reports of any sleep symptoms in service are accurate.

The clinician must provide reasons for each opinion given. In this regard, the clinician MUST consider the January 2018 statement from the Veteran's spouse, in which she reported that she witnessed the Veteran experience excessive snoring, gasping for air, and interrupted breathing while sleeping shortly following his separation from service in 1991.

2. Obtain an addendum opinion from an appropriate clinician regarding whether any diabetes experienced by the Veteran since approximately May 2014 at least as likely as not is related to an injury or disease during service, including environmental exposures in Southwest Asia during the Persian Gulf War

For purposes of the above opinion, the clinician shall presume that the Veteran's reports of any symptoms in service, including chronic sweats are accurate.

The clinician must provide reasons for each opinion given. In this regard, the clinician should consider the evidence in the Veteran's treatment records that he has experienced chronic sweats in the years since service and that this may be a symptom associated with his diabetes mellitus (see a VA primary care letter and a VA primary care treatment note, both dated in July 2009).

 

 

L. M. BARNARD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. A. Elliott II, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.